Provider Demographics
NPI:1437913316
Name:ROSEN, ANASTASIA EILLEEN
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:EILLEEN
Last Name:ROSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 JACKSON CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3165
Mailing Address - Country:US
Mailing Address - Phone:970-703-3114
Mailing Address - Fax:
Practice Address - Street 1:745 JACKSON CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3165
Practice Address - Country:US
Practice Address - Phone:970-703-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0026300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist